Who would be willing to take sides in the face-off currently taking place between the government and the province’s doctors?

Certainly not Ontarians who look to both to provide and fund health care.

But the Ontario Medical Association (OMA) is fighting the government to keep spending up at a time when all provincial governments are facing a reduction from the federal government in transfer payments for health care costs.

Ontario spends around 43 per cent of its budget on health care – more than $47 billion – annually. And, with an ageing population, and the fact that people are living longer, that figure is expected to increase drastically if something isn’t done to curb costs.

It appears that the way to solve this problem of increasing costs in this area is to find ways to restructure how money is spent and where the emphasis on program funding will be. Suggestions include moving doctors from a per service structure to a salaried structure similar to the pay structure in England. Some of that already exists here, but it is not consistent. There are also a number of ideas being presented by forward thinking physicians themselves about how to develop more systematically efficient and cost efficient structures within health care.

However, the negotiations between the government and the doctors are not really about salaries (at least, that is what we are being told) since the doctors have already agreed to a two-year pay freeze; it is about reducing the per service payments, particular those provided by cardiologists, radiologists and ophthalmologists. The government claims payments to specialists in these areas have skyrocketed in the past 10 years while, because of new technology, the time involved in providing these services has been greatly reduced, in some cases by as much as 75 per cent.

When times were better, annual increases in the health care budget looked like somewhere around seven per cent annually. But, the Ontario government has been running a growing deficit for the past three years, currently more than $16 billion, and with health care accounting for the biggest chunk of spending, it makes sense to look at ways to get that sector in line to begin balancing the books by 2017 as the McGuinty government says it wants to do.

According to Health Minister Deb Matthews, doctors are currently being paid an average annual salary of $385,000. Cardiologist earn on average almost $600,000 per year while diagnostic radiologists average $650,000. Some cataract surgeons earn more than $1 million annually.

The doctors say that what the politicians aren’t making allowances for when they refer to those figures is that about half goes towards the cost of running their offices, paying staff and purchasing medical equipment and other materials.

O.K. But what about doctors who work in groups, and in clinics? Don’t they not share those expenses?

And couldn’t other doctors who choose not to do so consider forming groups that can, even if they have their own individual offices, buy supplies in bulk to lower purchasing costs, for example?

These negotiations are being heated up as usual by the introduction of polarizing tactics. For the government and the OMA to vilify each other does no one any good. We have to have a reasonable, realistic approach to advancing health care, so that it continues to be the best it can be for the people of the province and to make it attractive enough for doctors to want to continue to practice here. It’s not as if there aren’t viable solutions. The question is why is there so much resistance to improving the system? The answer may lie in the fact that most doctors having a vested interest in maintaining the status quo. Yet, if the cost of health care spending is not adjusted it could mean reduction in other areas in order to compensate.

Doctors are an influential force and the government no doubt has a fight on its hands. What the public is hoping for is a resolution that does not diminish a public good that makes Canada one of the most desirable countries in which to live.

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since April 9, 1978.